Obsessive Compulsive Personality Disorder

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Abstract
The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxiety disorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score ≥16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxiety disorder which is phenomenologically well characterized and different from OCD, such as PD.

THE RELATIONSHIP between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) has been the subject of considerable debate and has been approached differently during the course of this century. The Freudian view was that obsessional neurosis was most likely to develop in an individual with an anal character or personality structure, defined by the specific triad of orderliness, parsimony, and obstinacy.1 Obsessive symptoms and traits were thought to reflect the operations of defense mechanisms against unconscious anxiety. According to this conceptualization and using a modern terminology, several authors stated that OCPD or traits are closely linked to OCD and can lead to OCD, and placed them on the same psychopathological continuum.2, 3 and 4 Since the introduction of DSM criteria, which were greatly influenced by the psychoanalytic approach and incorporated the anal triad, a number of studies examined the co-occurrence of OCPD and OCD. Using DSM-III criteria, OCPD prevalence estimates reported from structured interview studies ranged from 4% to 28%.5, 6, 7, 8 and 9 For DSM-III-R criteria, the frequencies of OCPD reported in OCD patients ranged from 3% to 36%; the only study conducted with DSM-IV criteria to date10 reported a frequency of 32.4% (see Table 1). Such a wide range of OCPD prevalence is mainly due to methodological differences across different studies; moreover, DSM-IV diagnostic criteria for OCPD represent a substantial change from those in DSM-III and even from those in DSM-III-R; the present version of DSM added four diagnostic criteria to those of DSM-III and discarded one. Over the years, the percentage of criteria required to make the diagnosis of OCPD has been substantially reduced, making it progressively easier for a patient to be diagnosed with this disorder and contributing to discrepancies of results among different studies. Table 1. Prevalence of OCPD in OCD Samples According to DSM-III-R and DSM-IV Criteria Authors| Date| No. of Patients| Instrument of Evaluation| Diagnostic Criteria| OCPD (%)| Stanley et al.14| 1990| 25|...
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